This invention relates to devices and methods for terminating hemorrhaging in colorectal surgery, and more particularly to devices and methods for terminating bleeding in the presacral venous plexus and the sacral basivertebral veins during surgery.
In colorectal surgery, certain incidents can give rise to massive bleeding that cannot conveniently be terminated by suturing or cauterizing. If the presacral fascia are inadvertently entered during rectal surgery, bleeding from the presacral venous plexus and the sacral basivertebral veins may occur. Due to the high density of blood vessels and high volume of blood flow in the region, inadvertent cuts result in severe blood loss which may lead to death in some cases. The urgency of the surgical procedure and the inaccessibility of the hemorrhaging site, as well as the severity of the bleeding, require that hemostatic measures of an unusual kind promptly be undertaken, as commonly used techniques such as packing the site or cauterizing the area often prove ineffective. It is known to terminate the bleeding by occluding or tamponading the vein, using a sterilized pin in the general form of a thumbtack and inserting it into the sacral vertebrae, in such a position that the pin itself or the head of the pin closes the vein. More than one bleeding site must often be occluded during these surgeries.
While this procedure has been used for a number of years, it is accompanied by a number of problems pertaining to uncertainties of inserting the occluder pin. Ideally the hemorrhage occluder pin should be inserted so that the head of the pin rests on the fascia or bone. However, because of the close confinement in the working area, it is not always possible to seat the head properly. Therefore it is important that the accidental dislodging of a partially inserted pin be as difficult as possible. This insures that the bleeding vessels will remain occluded during critical phases of healing and that an abnormal movement, jarring or trauma will not dislodge the hemorrhage occluder pin.
It is difficult in many instances to precisely position and insert the pin. The edges of the head of the pin are quite thin and the shaft of the pin is quite short, so that holding the pin with one's fingers is often difficult. The surgeon must use one hand to locate and control the bleeding while the other is used to handle the occluder. This often results in the pin being dropped and leads to chances of puncturing the surgeon's gloves and skin, exposing the surgeon to the risk of blood-transmitted diseases, such as hepatitis or acquired immune deficiency syndrome. In an improved, but not entirely satisfactory technique, the thumbtack is held at its shaft with a surgical clamp, and the surgeon positions and forces in the thumbtack before releasing the clamp. The typical clamp is cumbersome, obscures the surgeon's view and introduces some interference with the head or the shaft, or both, at the point of insertion. Moreover the straight length of the shaft may not permit convenient access to the bleeding site, or positioning in the proper relationship. Quick and certain application regardless of access problems cannot often be achieved by existing devices and procedures.
It can be seen then that an improved occluder pin is needed that is easily and precisely insertable into the sacral vertebrae but resists withdrawal. It can also be seen that improved application devices and methods of location and insertion are needed that position and securely hold the pin.